Ep 24 - Helping Someone Move Safely

When we are caring for another person we often need to help them move around. This episode offers some advice on some of the things you can do to protect yourself while helping them to move between furniture, or in a bed, safely.

Please also follow this link to watch videos on assisting someone, and also on giving someone a bath or hair wash in bed.
https://www.youtube.com/@otagocommunityhospice817/videos 

Written resources to support this podcast can be found here

Find out more about Otago Community Hospice via our website, facebook or instagram

Email us: endinglifewell@otagohospice.co.nz

We would love to hear from you. Send us your feedback and suggestions for future topics.

Transcript

Episode 24 – Helping Someone Move Safely

Kia Ora and welcome to The Ending Life Well Podcast. This podcast series for carers focuses on advice and practical solutions for carers who have been thrown into the deep end looking after a loved family member or friend in their last days, weeks, or months of life. 

Our episode today is Helping Someone Move Safely

Hi, I'm Denise van Aalst, a senior palliative care nurse and educator with Otago Community Hospice. Today I'll be talking with Graham Moginie, a physiotherapist and founding director of Back In Motion Physiotherapy Clinic. Graham has a particular interest in management of spinal pain and injury prevention, and is a member of the Pinc and Steel Cancer Rehabilitation group. Good morning Graham. 

Graham

Good morning

Denise

Graham I was keen to talk with you today, wanting to give some advice to people who are caring for somebody at home about how they can help keep themselves safe, while they're assisting them to move and to transfer. Because there are some real risks for people aren’t there, not only to the patient, but to the person doing the caring.

Graeme 

That’s right. I often see clients coming into my rooms that are both local residents, but also visiting the hospital from out of town and they're having to spend long times sitting caring for their loved ones, often in low seats or inappropriate seating arrangements holding one position for a long period of time and then coming out with neck pain, back pain or hurting their shoulders when they're helping assist them to move in the bed. So it is a very real issue. 

Denise

So I think you just touched on something that I probably hadn't really thought of, but a great deal of time can be spent sitting and that's just not good for us. So that on its own is going to affect people's muscles, isn't it? And then they go from those long periods of sitting, to doing something really active and bending perhaps. What could they be doing Graham that would just help give their body some protection and keep themselves supple and mobile?

Graeme 

A couple of things come to mind when you when you talk about this. The first thing is that we know that sitting for any length of time is quite stressful on the body And there's no such thing as perfect posture, and no one can hold a perfect posture more than 20 minutes. And then you start to slump and then you start to put stress on ligaments and then the longer you hold that stress, the more strain happens on that ligament and you end up with discomforts and pains and just stiffening. And you'll know this when you sit for a long period of time and you stand up and you can hardly straighten up and you think ‘oh I'm really stiff and tight’ and you need to move around a bit and warm your body up to feel comfortable. So the first point that I like to make to people is you're going to have to sit but just about every 20 minutes move, change your position. So move around, change your position. Stand up, stretch your back out the opposite direction, have your hands on your hips and lean back, moving your neck around a bit before it gets too strained. And you do that just in a gentle manner. So realise that a lot of people that are looking after their loved ones are in the older age groups. So tissues are even stiffer again, just through natural aging. And you may be carrying some old war wounds, some old strains and sprains, some old operations. So you have less tolerance, you have less muscle bulk as you get older, so you can't hold a position. So you end up straining more readily. So when we say move around, a lot we just mean stand up, stretch wave your arms around a little bit, roll your shoulders, move your neck, stretch your body, and then you can sit down again. And then your muscles have all refreshed and then you can last a bit longer again. So it does mean that you're regularly moving around. And it probably sounds tiring, but it's actually quite good for you. In fact, it's more energising than tiring. 

Denise

I actually often recommend that people turn their chair around so that they are facing the person in the bed rather than sitting in a line with them, actually facing them. Because then they don't have to be so twisted, but that getting up every, you know, 15-20 minutes and just doing those stretches you talked about, I can I can actually imagine how that would just wake my body up. And I would feel better for doing that. And it's quite simple enough, isn't it just to set that body clock to get up and do those movements?

Graeme 

Right, Yeah. So you can even set your watch to it. Or you just look at the clock. And every time the hour comes around you think right, I might just do a few movements. But I always add a little caution on that. We tend to say just move within your normal limits. Don't try and achieve great flexibility, you're never going to be as flexible as when you were 15 or 20. And if you are carrying some old pains and aches it might pay to check in with your physiotherapist about what you can do while you're in the room. By the way, this also applies to the person you're caring for, because they can do some movements with you. And the same reasonings why it's good for you to get your blood flowing around your body not only to refresh your body and your muscles, but also your brain. It's also good for them to do the same thing in a probably a more, a lighter way perhaps, but it makes them feel a bit better too. 

Denise

That's a really good point. Because, you know, not everyone who's unwell is bed bound, but they may be spending a great deal of time sitting in a chair. So getting them to move, as they can safely, and doing those gentle stretches is going to be good for them as well.

Graeme 

Well that's true. We're assuming the worst case scenario is that they're lying bed bound. But yes it's about setting small goals for the person you're caring for. A little short walk to the door and back and that's the morning’s effort done for them. They've got up, you've helped them up. And that'll’ that'll probably move us into how you move people out of your chair and transferring loved ones. And so getting them up and moving around and walking with them is good for you, good for them.

Denise

So you're right, that leads us into helping someone else to move and transfer. So what are some of the key things if I'm going to help someone stand up? What are some of the key things I need to keep in mind before I do that?

Graeme 

So one of the key points, get them to move as much as they can, rather than you try to position them. So tell them what you want to achieve. You've got to wiggle one leg forward then the other leg forward and grab hold of the arms of the chair and just wiggle forward to the edge of the chair. Have their feet a bit further back behind their knee joint. And you're going to tell them to push their head forward, gaze towards the wall. All movements lead from the head. And so if your head is coming forward, and your feet is back a little bit that's going to help you rock forward up into the standing position

The problem we find with a lot of people is this natural tendency to rock back. And so they tend to look up and lean back. And that's when the caregiver can really get strained because you've got your feet positioned in the direction of travel, and you've got your hips and body positioned to allow the motion to happen. But then they pull back on you. And they often look up with their head. So the whole body mass is going back into the chair as they try to stand up straight. So you get this diabolical situation where you're having to hold them and you're bending and twisting. And if you've got a bit of a history of back strains, which let's face it, a lot of us do, then guess what you can strain. Particularly if you’ve been sitting around for the last week or so stiffening up, and then you go and put this sudden force on and then they're pushing back against you. So key points, head forward, look up, feet back, positioning at the edge of the chair and count. So you know that on the number three count, that's when you're moving so they know when to engage their muscles. So you're trying to use their momentum so they're rocking back and forward, one two three and up and you sway your body mass with them. So suddenly, it becomes easy rather than dragging a dead weight.

Denise

So the other thing to keep in mind isn't it, is your own posture. You know, I think that's really great that rocking, that assisting, that counting to stand, are all really key points. But there's also ‘so what am I going to do?’ So I need to keep my own back straight, and it's a crouching rather than bending, isn't it? So that we're using those large muscles through our legs and our buttocks rather than bending with our back?

Graeme 

Exactly. There’s always this kind of standardisation of bend your knees and keep your back straight and shoulders back and this will be perfect and the person is going to be well behaved in front of you and then you can lift and move like a robot and it's all a perfect scenario. When the reality is you gotta lean over the edge of an arm chair. You've got a little side table in the way and a hospital bed in the way or your own bed and you're tired. And you're thinking oh now I've got to use my glutes and my quads and my back muscles and your brain doesn't kind of recognise that. And so one of the key cues that we like to use for people is to think well, I'm going to pull my chin in a little bit to protect my neck, so not dramatically, just a little bit. So just chin in, first cue. Second cue, shoulders back a little bit. So you're engaging your shoulder blades, this sets your shoulder joints into a good position, and allows your muscles to connect and hold them stable. Rather than being overreached forward where they’re at an unstable position, You're going to be using more arms, then core to get your person up. So chin in, shoulders back a little bit, just squeeze your shoulders. And then we use this word, the B line. So that could be short for belly button line, abdominal muscle. So I'm sucking my tummy in. That helps engage deep postural muscles into your spine, as well as your deeper abdominal muscles to position your spine and hold your spine and allow the bigger muscles to then engage. And then you can squeeze your glutes a little bit, and then you're doing your count. So you're breathing while you do the count one, two, and on three, take a breath in and hold. And that engages all these right muscles to make your whole central part of your body a rigid, strong cylinder, and therefore you're less likely to strain your muscles as you position. So it's often when I'm taking client histories of how did you strain your shoulder or your back, when you're positioning your person you are caring for? Often it’s ‘I was half asleep, it was the middle of night, and I just didn't think I just reached forward and tugged and then, you know, I twisted and then I strained my neck, strained my shoulder. So if you think about ‘cue’ing, rather than your anatomy, that tends to engage things automatically. 

Denise

Yeah, and you're right, it's when we're vulnerable, isn't it? We're tired. It's the middle of the night. It's been a long day, something like that. So if we practice these moves several times during the day, we can help lock it in so that it becomes a little more instinctive when we are tired in the middle of the night to remember one two three four, these are the steps I need to do. Just to protect myself.

With the breathing, I was interested that you said to hold your breath, I thought that breathing out was a good thing to do. Can you just talk us through that?

Graeme 

So when we're teaching people to do deep abdominal training and back muscular training for holding your spinal position when doing everyday activities, we know that your spine is held up by automation. Your body's subconscious brain is keeping me upright right now as the muscles are changing and holding, and these are the deepest structures, they don't hold much power, they can exert about five kilograms of force. And they’re just there all day long. They're your marathon runners, they're your endurance muscles. They're small, they don't generate much horsepower, but they hold position. On top of that, you need strong muscles and we know where they are. You can see them physically, you've got your big six packs, your pecs, your big quads, your glutes. They’re your big, dynamic, powerful muscles. So we know that when we want to really exert a heavy lift, it's often good to hold your breath to do something really heavy as compared to, those muscles switch off to a large degree when you're doing a lighter activity, and you need your endurance muscles. So we encourage breathing out or breathing in. So you're not holding your breath to engage large muscles, you're trying to facilitate the smaller endurance muscles. So, if you're doing a light task, you want to be breathing. And that's exerting good postural control. So we do need to think about two systems here. One is lifting and one is holding position. So when I'm leaning over caring for someone, washing them, attending a dressing you will be leaning over, you want the muscles to hold that position and not feel that ache in your back.

Denise

Great. That makes a really good description, so thank you for that Graeme. We talked about helping somebody stand. What about when we're trying to help somebody sit back down in a chair? Because when somebody leans back, if we’re trying to hold them up and they lean back, that's another time that we might be vulnerable, isn't it?

Graeme 

Exactly. And always think that they're probably the least likely to get hurt because they're going to plonk into the chair. I treat a lot of nurses who have quite graciously tried to save the patient from collapsing to the floor. But I never treat the patient it seems. They’re relaxed and they flopped to the ground. And the poor nurse comes in with a disc herniation or ruptured rotator cuff. 

Denise

Let's touch on that for a moment, Graeme. If somebody is falling, the reality is we cannot stop them falling, can we? But we are going to put ourselves at risk if we try. So, you know, even a very petite person weighs a great deal, by the time they hit the floor, when they're falling. 

Graeme 

You just need to be thinking, ‘right, we're going to the ground and I'm going to going to guide you down’, hand on the head, protecting as they go down, soften the landing. And it comes to the initial position you're in anyway. So as you're sitting someone down in an arm chair or onto the side of the bed, you've got one foot quite well forward, pointing in the direction of travel and the other foot lunged backwards. So you know, lunge position, So when things go to custard, the body is falling a bit too rapidly, you're just going onto your front leg, your giant spring of quadriceps is taking the load and you've got your B line engaged, shoulders back, and you're just lowering into the chair so they just might fall a little more rapidly into the chair. And you're acting as a little bit of a bodyweight handbrake, but you're not stressing your body, you’re just swaying onto your front leg. If you had both feet together, your back just bends in half. And then you you've got a risk of strain because you're taking all this weight out on outstretched arms, high leverage and body leaning down, magnifies the force massively into your low back and shoulder area. So foot astride, lunge position, feet pointing to where you're going, holding behind back and then just assist the lowering. It means you're just moving into a lunge basically so there’s less risk.

Denise

And for the person that's being sat down, if they're backed up to the chair, if they can feel the chair behind them and ideally put their hands on the armrest, then they know it's safe to go where they're going because they're going to land in the middle of the chair. 

The other thing that I've learned is if they bend a little bit and poke their bottom out, they'll go further back in the chair than if they just sit straight down. So that's a handy hint for getting somebody further back

Graeme

Yeah It's a good point. 

Denise

Graeme the other thing that I'd like to just sort of touch on is when we are caring for somebody who's in bed, there's a few things, isn't it that are worth knowing about. One of them is that the bed should be at hip height, if possible of the shortest person. And that's the safest height for us if we're helping somebody move around in the bed, so if there's a hospital bed at home that you can raise or lower, or perhaps putting blocks under the legs of the bed if you using your own bed to raise it up to hip height. That keeps it safer for the people doing the work? 

Graeme 

Yeah, that's right. You just keep everything at that height, so you're not bending too much at the waist. The tall person, though, still at a bit of a disadvantage there. So he's got to do a deeper squat, deeper lunge. So they've got to go to the side where the good knee can bend more. And so here we are getting away from the ideal situation into more of a real situation. And that's where you need to be building up the muscles of your back, and doing your breath hold and your count, and using your stronger abdominal muscles and back muscles. And again, sometimes, it is a timely reminder for some people that are getting a bit sedentary, to talk to a physiotherapist that is trained in this area to give them some simple drills just to get a little bit stronger, more supportive, awaken those muscles. They don’t have to be a gym junkie, they just need to do a few simple things at home to start to fire those muscles to protect themselves so they can help their loved one.

Denise

That's so that's a really good point and Graeme there was something else, you just said that I've heard you say before about getting the muscles firing, and that if we're going to assist somebody doing a few squats, and bends first, fires our muscles up and gets them ready to work before we put any load on them. And, you know, we see, we see athletes do that all the time. Wouldn’t necessarily think of doing that at home, but our carers are athletes, you know, so doing those squats and getting their muscles fired up before they start trying to move someone else is really good protection.

Graeme 

Oh, absolutely, yeah, you'll see that the athletes often they want the reserves, they're sitting down, they're cooling off, they’re stiffening. And the role of the trainers is to get them up every few minutes. And they run up and down, toss the ball around, to keep the blood pumping around so you can take that analogy and think right well, these people are older, stiffer, sitting for a long period of time. And we think oh, we need to shift the person up the bed. So we think well, we're going to do that soon. Right I will stand up and I'll do some general stretching, some warm up movements, I could do some shoulder circling, I can start to engage the muscles. By doing my B line and some breathing I’m firing up the deep abdominal muscles. I do a few squats. Just small little knee dips is enough to fire the muscles and you're tightening your B line at the same time to start to engage all those muscles. The brains going ‘Oh right. Those ones. Right I need to start getting them ready’. And then you go and do your lift and that that can just help protect you.

Denise

Graeme, you touched on something there too, which I think is another key point, when we're assisting somebody, it was around the toileting.  I know that that's often a risky time when people are perhaps trying to move around, they might be using a frame, they're trying to turn around, get to the toilet, maybe get their skirt up, or their pants down all at the same time. And that's when there's a real risk of a fall, isn't it? So it is remembering to do one thing at a time. So it's stand, its turn, it's walk, it's turn, stop, then lifting the skirt. Because if we're trying to do too many things at once, that's when falls can often happen.

Graeme

Do one thing at a time just and just strategise it with everybody. You might be two people, maybe three people in the room, might just be yourself, and the person. So make a plan, clear the space, make sure you got a good straight line to where you're gonna go, and when you're going to turn. So they know they can help you by shuffling their body weight, wiggling their feet around. And making sure they’re right up against the toilet, before you twist, so they're not too far away. So positioning them really well, so the backs of their legs just touching as they lower down, you're got your foot to one side of the toilet and you're just lowering down and you've got your hand around their back. And then then you can then lower down from there.

Denise

And when you spoke about clearing the space, and you mentioned earlier about the bits and pieces of furniture around, actually decluttering the space is hugely helpful as well isn’t it?  If we can take away some of the unnecessary clutter. And I'm not for a moment suggesting rooms should be bare and barren, like hospital rooms often are. But removing some of the unnecessary clutter so that where you do have to move the space is clear, that also helps keep everybody safer.

Graeme 

Correct. And I think one of the things that does spring to mind is the favourite rug that's a bit mobile, it can scrunch up. I mean, that's the danger for everybody to trip over the rug. And then then we've got a disaster on our hands.

Denise

So now is time to roll that rug up and tuck it away.

Graeme 

I have treated quite a few people that have had cancers and they've fallen and broken ribs, it just complicates everything. So the more you can avoid a fall, the better. So the rug gets rolled up and the floor is clear, non-slippery, and also non slip mats are very, very good as well if you've got a very slippery lino floor or around the bathroom, you want to put a non-slip mat in there or you got your mat that's your normal bathroom mat with a non-slip rubbery thing underneath. I treat enough people that have slipped coming out of the bath that are fit and healthy and well. And they've just taken a step out of the bath and then they’ve gone for a skate and damaged themselves. So it’s even worse if you're a bit fragile.

Denise

Yeah. And you’re right. That non slip mat that you can buy by the roll that works really well under bath mats, in the shower. It's easily cut to fit and can be thrown into wash with the towels. So you know it's a simple, inexpensive purchase that just avoids slipping. 

Graeme, thank you for that. I really appreciate you joining us today. It's really helpful. And hopefully we've got some tips here that can help people keep themselves safer. There is a video available at otagohospice.co.nz, there's some videos that they can have a look at. There's also a website that you've told me about pincandsteel, that's PINC and steel.com. And that's got some great information for people who are recovering from cancer around exercise and keeping themselves safe. So thank you, Graham.

Graeme

My pleasure. 

Denise

And thank you listeners for joining us today. 

Otago Hospice have created videos demonstrating how to safely assist people to move and transfer in a number of ways. These videos also include caring for somebody who is in bed. The videos are available at otagohospice.co.nz/education along with further written resources about caring for a person who's dying. 

 This podcast was brought to you by Otago Community Hospice, with support from Hospice New Zealand.

If you found this discussion helpful, check out our other episodes of Ending Life Well, a podcast series for carers. 

The Helping Someone Move Safely videos to accompany this podcast can be found here:

https://www.youtube.com/@otagocommunityhospice817/videos